Can you take aspirin and Cardizem (diltiazem) at the same time?

Taking Aspirin and Cardizem (Diltiazem) Together

Yes, aspirin and Cardizem (diltiazem) can generally be taken together safely, but this combination requires monitoring for potential bleeding risk, especially in patients taking direct oral anticoagulants (DOACs). 1

Safety and Interactions

• Diltiazem does not significantly impair warfarin clearance and appears to be a safer calcium channel blocker option when anticoagulation is needed 1
• Unlike verapamil (another calcium channel blocker), diltiazem did not significantly increase plasma concentrations of apixaban, making it a more suitable combination in many circumstances 1
• However, diltiazem is a moderate inhibitor of CYP3A4 and P-glycoprotein, which may increase bleeding risk when combined with certain DOACs, particularly dabigatran 2

Specific Considerations Based on Medication Combinations

Aspirin + Diltiazem

• This combination is generally considered safe for most patients 1
• Some studies show diltiazem may have its own mild antiplatelet effects, which could theoretically enhance aspirin's effects 3
• In rare cases, the combination produced prolonged bleeding times in research subjects 3

Diltiazem + Anticoagulants (if also prescribed)

• Recent research shows increased bleeding risk when diltiazem is combined with dabigatran (but not with warfarin) 2, 4
• The bleeding risk was observed even in patients with normal kidney function 4
• For patients taking DOACs with diltiazem, monitoring for signs of bleeding is recommended 2

Diltiazem + Beta-Blockers

• Caution is needed when combining diltiazem with beta-blockers due to potential cardiac conduction effects 5
• Patients should have blood pressure, heart rate, and ECG monitored when on this combination 5

Clinical Scenarios Where This Combination Is Used

• Post-bioprosthetic valve implantation: Adding aspirin to anticoagulation may decrease thrombotic events (1.0% vs 0.6%) but increases bleeding risk (1.4% vs 2.8%) 1
• Coronary artery disease: Aspirin is recommended for secondary prevention after myocardial infarction 1
• Atrial fibrillation with coronary disease: Combination therapies may be needed but require careful risk assessment 1

Monitoring Recommendations

• Monitor for signs of bleeding, especially gastrointestinal bleeding 1
• For patients also on beta-blockers, monitor heart rate and cardiac conduction 5
• For patients with impaired renal function, closer monitoring is warranted as drug clearance may be affected 2

Precautions

• Patients with a history of bleeding or peptic ulcer disease have the highest risk of GI bleeding with antiplatelet therapy 1
• Advanced age significantly increases the absolute risk of upper GI bleeding with antiplatelet therapy 1
• Consider proton pump inhibitors for patients at high risk of GI bleeding who require this combination 1
• Avoid this combination in patients with significant bradycardia, heart block, or hypotension 5

In summary, while aspirin and diltiazem can generally be taken together safely, the combination should be used with appropriate monitoring, especially in patients with additional risk factors for bleeding or cardiac conduction abnormalities.